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Which client statement alerts the nurse that the stage of depression may have started within the grief process? "I am going to see another doctor - this diagnosis is wrong." "I just need to live long enough to see my daughter get married." "I need to get to the attorney to finish my will." "I can't seem to stop crying about the diagnosis."

"I can't seem to stop crying about the diagnosis." Explanation: Depression is characterized by a sad mood, such as continual crying. Other statements reflect acceptance, denial, and bargaining.

The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the bargaining stage of grief is the one who states: "I don't care about anything. I have no energy." "I just want to see my son have a family of his own." "I do not believe I have this disease." "Why did this have to happen to me?"

"I just want to see my son have a family of his own." Explanation: The client is expressing the bargaining stage of grief when attempting to barter for more time, as in the statement, "I just want to see my son have a family of his own." The other statements are reflective of other stages of grief.

Which client statement would cause the nurse to suspect that the stage of bargaining has been reached in the grief process? "I am going to see another doctor. This diagnosis is wrong." "I need to get to the attorney to finish my will." "If I can just live long enough to see my daughter get married." "I can't seem to stop crying about the diagnosis."

"If I can just live long enough to see my daughter get married." Explanation: Bargaining, a psychological mechanism for delaying the inevitable, involves a process of negotiation, usually with God or some other higher power. Usually, dying clients have come to terms with their death, but want to extend their lives temporarily until some significant event takes place (e.g., a child's wedding). Finishing a will indicates acceptance, seeing another doctor indicates denial, and continuous crying indicates depression.

The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the anger stage of grief is the one who states "Why did this have to happen to me?" "I just want to see my son have a family of his own." "I don't care about anything. I have no energy." "I do not believe I have this disease."

"Why did this have to happen to me?" Explanation: The client is expressing anger when displaying a "why me" attitude. The other statements are reflective of other stages of grief.

Which assessment finding would best support a nursing diagnosis of Dysfunctional Grieving? A woman cries frequently and loudly in the weeks following her child's death in an accident. A man is unable to return to work after his sister's death 18 months ago. A woman has been experiencing chronic insomnia since her mother's death earlier this year. A man blames himself for not doing more to make his wife's recent death more comfortable.

A man is unable to return to work after his sister's death 18 months ago. Explanation: An inability to return to normal activities 18 months after a sibling's death is suggestive (though not definitive) of Dysfunctional Grieving. Crying and having difficulties sleeping are not unusual and will often accompany healthy grieving. A feeling of "not doing enough" is common during grief and

The nurse has noted that a dying client is increasingly withdrawn and is often teary at various times during the day. The nurse recognizes that the client may be experiencing which of Kübler-Ross's stages of grief? Anger Depression Bargaining Denial

Depression Explanation: Depression is a commonly accepted form of grief and it represents the emptiness when the client realizes the person or situation is gone or over. Signs and symptoms may be withdrawn, sadness, crying, and flat affect. Denial is the stage where client may disregard that the news of diagnosis or death is not true. Anger is the stage where the client may think "why me?" and "life's not fair!" Bargaining is the stage of false hope. The client might falsely make themselves believe that they can avoid the grief through a type of negotiation. The stages are denial, anger, bargaining, depression, and acceptance.

A terminally ill client told her family, "I am ready to die." Her family is very upset that she has given up and wants the nurse to intervene. Which nursing intervention is most appropriate? Explain to the family that giving up is expected with terminal illness. Encourage the client to think about living instead of dying. Explain to the client that she cannot give up because her family needs her. Explain to the family that acceptance is part of the grieving process.

Explain to the family that acceptance is part of the grieving process. Explanation: Acceptance (an attitude of complacency) occurs after clients have dealt with their losses and completed unfinished business. After tying up all loose ends, dying clients feel prepared to die. Some even happily anticipate death, viewing it as a bridge to a better dimension. Nurses can help clients to pass from one stage to another by providing emotional support and by supporting the client's choices concerning terminal care. Facilitating the client's directives helps to maintain the client's personal dignity and locus of control. Accepting that death will occur and giving up are not the same thing and giving up is not expected.

A nurse is providing care to a terminally ill client. Which finding would alert the nurse to the fact that the client is dying? Select all that apply. Strong, bounding pulse Regular deep respirations Irregular heart rate Pale, cool skin Decreased urine output

Pale, cool skin Decreased urine output Irregular heart rate Explanation: Signs of dying include extremely pale, cyanotic, jaundiced, mottled or cool skin; irregular heart rate; weak, rapid, irregular pulse; shallow, labored, faster, slower, or irregular respirations; and decreased urine output.

The family of a client with a severe traumatic brain injury is considering the withdrawal of the client's mechanical ventilation. What is the nurse's primary role in the preparation for terminal weaning? educating the family on what to reasonably expect after ventilation is discontinued assisting with pulmonary resuscitation if the client is unable to breathe independently assisting with chest physiotherapy before and after ventilation ceases preparing the bedside for postmortem care

educating the family on what to reasonably expect after ventilation is discontinued Explanation: The nurse's role surrounding terminal weaning is to educate and assist as needed in the decision process. It would be premature and possibly upsetting to prepare the bedside in anticipation of postmortem care. Chest physiotherapy and resuscitation would not typically be attempted in cases of terminal weaning.

The health care provider has notified the spouse of a client who died after a serious motor vehicle accident that all rescue efforts were unsuccessful, and that the client regrettably died. Several hours later, the nurse notes that the spouse is walking the hallways, asking people if they have seen her husband. Which condition does the nurse suspect? idealization shock developing awareness restitution

shock Explanation: The client's spouse is showing signs of shock because she has not processed that her husband died. Developing awareness involves the physical and emotional feelings of sickness, sadness, emptiness, and/or anger. Restitution takes place when the person recognizes loss, and idealization takes place in the form of an exaggeration of the good qualities of the deceased.

A client has been receiving dialysis for years and now states, "I have been thinking about this for a long time. I no longer wish to continue dialysis. I just want to die." What is the most appropriate statement by the nurse? "Does your family agree with this decision?" "Once you've started treatment, it's important to continue." "Have you discussed this with your health care provider?" "Can you tell me about why you've made this decision?"

"Can you tell me about why you've made this decision?" Explanation: Having the client explain his decision-making process is open-ended and allows exploration of the client's feelings. A competent client is not required to continue with treatment that has been initiated. The other options are closed-ended and stop any further conversation.

The psychologist is teaching students about the factors that affect a person's reaction to grief. Which statements by the students about developmental considerations are accurate? Select all that apply. "Death of a parent can delay a child's development." "Children understand death on the same level as adults." "Children do not need to go through the same grief reactions as adults." "Terminally ill children normally do not ask questions about death." "Sense of loss for a child is just as great as it is for an adult."

"Death of a parent can delay a child's development." "Sense of loss for a child is just as great as it is for an adult." Explanation: Children do not understand death on the same level as adults, but their sense of loss is just as great. Death of a parent or another significant person can delay a child's development. Both terminally ill children and their siblings are likely to talk and ask questions about death. Children need to go through the same grief reactions as adults.

The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate? "It must be very difficult for you." "You should try to make things right with your family." "I can't imagine how awful this is for you." "There's no need for anger."

"It must be very difficult for you." Explanation: Use statements with broad openings such as "It must be difficult for you" and "Do you want to talk about it?" Such language encourages communication and allows the client to choose the topic or manner of response. Accept the client's behavior. Anger is part of the grieving process. Indicating that this is "awful" is not an appropriate way to promote coping. It is not the nurse's role to tell the client to make things right with family. While this may be desired, the client should initiate it.

The psychiatrist is evaluating a client who has recently learned she has a terminal illness. Which statement indicates to the psychiatrist that the client is in the Kübler-Ross stage of bargaining? "I know that my family will be taken care of. I am at peace." "Why is this happening to me—I quit smoking." "I waited years to see my grandchildren and now I won't see them." "Just let me go on vacation with my wife; then I'll be satisfied."

"Just let me go on vacation with my wife; then I'll be satisfied." Explanation: According to Kübler-Ross, the five stages of dying, with common reactions are: denial, anger ("why me" questions), bargaining (the client tries to barter for more time ("just let me go on vacation..."), depression ("I waited years to see my grandchildren and now I won't"), and acceptance ("I am at peace.").

The nurse is caring for a client who recently found out he has a terminal illness. The nurse notes that the client is hostile and yelling. Which statement by the nurse shows that she has understanding of the Kübler-Ross emotional responses to impending death? "Sometimes a person returns to a previous stage." "Each stage of dying must be completed prior to moving to the next stage." "The process is the same from person to person." "The duration of all stages is a few hours."

"Sometimes a person returns to a previous stage." Explanation: Kübler-Ross (1969) studied the responses to death and dying. Her findings are as follows: Sometimes a person returns to a previous stage; the stages of dying may overlap; the duration of any stage may range from as little as a few hours to as long as months; the process varies from person to person.

Upon interviewing the client, the nurse finds that the client is providing care for her mother who is terminally ill. The client is depressed and already mourning the loss. Which nursing diagnosis would be most appropriate for the client? Anticipatory grieving Normal grieving Prolonged grieving Dysfunctional grieving

Anticipatory grieving Explanation: Anticipatory grieving is the most appropriate nursing diagnosis for this client. It comprises the intellectual and emotional responses and behaviors by which individuals, families, and communities work through the process of modifying self-concept based on the perception of loss. Normal grieving, dysfunctional grieving, and prolonged grieving are inappropriate diagnoses because they can only happen after the actual loss.

The nurse is caring for a client who has just expired. Which action will the nurse perform? Place the client in a semi-Fowler's position. Allow the client's family to see the client's body before it is discharged. Provide a complete bath. Have the nurse technician place identification tags on the outside of the shroud.

Allow the client's family to see the client's body before it is discharged. Explanation: After the client has been pronounced dead, the nurse is responsible for preparing the body. Family members may need to see the client's body to accept the death fully; allow them to see the client's body before discharging to the mortician. The body is placed in normal anatomic position (flat) to avoid pooling of blood. In most cases it is unnecessary to wash the body, and some religions strictly forbid it. The nurse is legally responsible for placing identification tags on either the shroud or garment that the body is clothed in, and on the ankle to ensure that the body can be identified even if separated from its shroud.

A client at a health care facility has died after a prolonged illness. A nurse is assigned to perform postmortem care for the client. Which intervention should the nurse perform when providing postmortem care? Cleanse drainage from the skin. Apply hairpins and clips. Avoid replacing dentures in the mouth. Place a rolled towel under the head.

Cleanse drainage from the skin. Explanation: The nurse should cleanse secretions and drainage from the skin to ensure delivery of a hygienic body. The dentures should be replaced in the mouth as they maintain the natural contour of the face. A small rolled towel is placed beneath the chin of the client to close the mouth; it is not placed under the head. The nurse should remove all hairpins or clips to prevent accidental trauma to the client's face.

When planning care for a 55-year-old male client with newly diagnosed terminal pancreatic cancer, which nursing diagnosis would be most appropriate? Ineffective coping Death anxiety Impaired comfort Failure to thrive

Death anxiety Explanation: The data the nurse collects about how a client or the client's caregivers are responding to an actual or impending loss or to impending death may support several different nursing diagnoses. Death anxiety is common when the diagnosis is new and is related to inability to predict how the last stage of illness will play out. Coping mechanisms are important in the dying process and will need to be assessed to determine their adequacy. Failure to thrive is not appropriate for this client and his medical diagnosis. Impaired comfort may be appropriate but is not as important as death anxiety at this time due to the newness of the client's diagnosis.

When assessing a person who is grieving using the grief cycle model, which concept would be most important for the nurse to keep in mind? Select all that apply. Stages occur at varying rates among people. Some people actually skip some stages of grief altogether. People vary widely in their responses to loss. The stages of grief occur linearly and are static. The stages are relatively discrete and identifiable.

People vary widely in their responses to loss. Stages occur at varying rates among people. Some people actually skip some stages of grief altogether. Explanation: In reality, the stages of the grief cycle model are not as discrete as the model indicates. However, it is helpful to use the model as a general guide, while keeping in mind that people may vary greatly in their responses to loss and still fall within the normal response range. Grieving persons may go through the stages at varying rates, go back and forth between stages, or skip stages.

The husband of a client who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing? Unresolved grief Inhibited grief Normal grief Anticipatory grief

Unresolved grief Explanation: In unresolved grief, a person may have trouble expressing feelings of loss, may deny them, and the bereavement may extend over a lengthy period. Anticipatory loss or grief occurs when a person displays loss and grief behaviors for a loss that has yet to take place. Inhibited grief occurs when a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations. Normal expressions of grief may be physical (crying, headaches, difficulty sleeping, fatigue), emotional (feelings of sadness and yearning), social (feeling detached from others and isolating oneself from social contact), and spiritual (questioning the reason for the loss, the purpose of pain and suffering, the purpose of life, and the meaning of death).

A client has a diagnosis of bladder cancer with metastasis. The client asks the nurse about the characteristics of hospice care. The nurse should explain that: symptoms of terminal illness should not be treated. care is premised on the fact that dying is a normal process. the client must be within 6 weeks of his expected death. care is generally guided by nurses rather than physicians.

care is premised on the fact that dying is a normal process. Explanation: Hospice care is premised on the fact that dying is a normal process. Symptoms are treated aggressively in order to preserve comfort. Care is interdisciplinary and admission usually requires a 6-month life expectancy or less.

The nurse is caring for an older adult comatose client in his home. The client is dying, and the client's family is providing some care. The family asks, "What else can we do?" The nurse encourages the family members to: speak to the client. elevate the client's head to a semi-Fowler's position. provide ice chips for the client's dry mouth. bathe the client daily.

peak to the client. Explanation: Dying clients may retain the sense of hearing until death ensues. The nurse should tell the client's family to communicate to the dying family member. Ice chips may be given to clients who are still able to swallow. This client cannot cooperate in swallowing. Position the comatose client in a semi-prone position to allow drainage of saliva. The client may need to be bathed frequently, not daily.

The children of a male client with late-stage Alzheimer disease have informed the nurse on the unit that their father possesses a living will. The nurse should recognize that this document is most likely to: give permission for organ donation. dictate how the client wants his estate handled after his death, and by whom. make legal provisions for active euthanasia. specify the treatment measures that the client wants and does not want.

pecify the treatment measures that the client wants and does not want. Explanation: Living wills provide instructions about the kinds of health care that should be used or rejected under specific circumstances. The management of an individual's estate is specified in a will, not a living will. It is not legal for a living will to make provisions for active euthanasia. A living will may or may not include reference to organ donation, but normally this is addressed in a separate, specific consent card or document.

A nurse completing admission paperwork asks the client about having an advanced directive. The client states, "I do not know, what is an advanced directive?" What is the nurse's best response? "It is a document created by you and your attorney naming a benificiary to handle your estate if you become terminally ill." "It is an agreement that authorizes the hospital to make decisions on your behalf, if you become incapacitated." "It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition." "I will contact the hospital social worker to come and discuss the development of an advance directive with you."

"It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition." Explanation: An advance directive is a written statement identifying a competent person's preferences regarding which medical interventions to use in the event that the client can not make a decision for themselves concerning terminal care. The other responses are not correct.

When preparing for palliative care with the dying client, the nurse should provide the family with which explanation? "The client will have to go to an inpatient hospice unit in order to receive palliative care." "In palliative care, no attempts are to be made to resuscitate a client whose breathing or heart stops." "Palliative care is the gradual withdrawal of mechanical ventilation from a client with terminal illness and poor prognosis." "The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms."

"The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms." Explanation: Palliative care involves taking care of the body, mind, spirit, heart, and soul. It views dying as something natural and personal. The goal of palliative care is to give patients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms. A do-not-resuscitate order means that no attempts are to be made to resuscitate a client whose breathing or heart stops. Gradual withdrawal of mechanical ventilation from a client with a terminal illness and poor prognosis is called terminal weaning. Clients do not have to be in an inpatient hospice unit to receive palliative care.

The daughter of an older client is concerned that her mother is depressed because she is reading the obituaries every day. What is the most appropriate nursing response? "This indicates that your mother is entering into the bargaining stage of grief." "This is a sign of impending death and we need to notify the provider." "This is a clear indicator that your mother is depressed." "This is common in older adults and doesn't necessarily indicate depression."

"This is common in older adults and doesn't necessarily indicate depression." Explanation: Older adults may read obituaries and death notices in the newspaper daily in an effort to keep up with acquaintances. Although this activity may be viewed as potentially depressing, it may be an effective coping mechanism in helping to develop a peaceful and accepting attitude toward death. The other responses are not appropriate.

When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response?

"This must be very difficult for you." Explanation: The nurse should use statements with broad openings, such as "This must be difficult for you" to allow the client to continue expressing concerns, and acknowledge the client's feelings. This facilitates communication and allows the client to choose the topic or manner of response during this stage of the grieving process. Assuming the client is angry and sad, or indicating that this is "a terrible diagnosis" is not an appropriate way to promote coping. The nurse should automatically assume a spiritual leader is desired.

An appropriate nursing diagnosis for the family of a client dying of cancer, whose members have expressed sorrow over the forthcoming loss, would be: Potential for Grieving related to loss of family member and sorrow Dysfunctional Grieving related to the loss of family member, as manifested by behaviors indicating anxiety Anticipatory Grieving related to loss of family member, as evidenced by sorrow Dysfunctional Grieving related to future loss of family member, manifested by family's developmental regression

Anticipatory Grieving related to loss of family member, as evidenced by sorrow Explanation: Anticipatory grieving comprises the intellectual and emotional responses and behaviors by which individuals, families, and communities work through the process of modifying self-concept based on the perception of loss.

A client severely injured in a motor vehicle accident is rushed to the health care facility with severe head injuries and profuse loss of blood. Which sign indicates approaching death? The arms and legs are warm to touch. The client is calm and peaceful. The frequency of urination decreases. Client's breathing becomes noisy.

Client's breathing becomes noisy. Explanation: Noisy breathing, or death rattle, is common during the final stages of dying because of the accumulation of secretions in the lungs. Reduced urination is not seen during the final stages of dying. Instead, the client develops loss of control over bladder and bowels due to loss of neurological control. The peripheral parts of the client's body such as the arms and the legs are cold to touch (not warm) because the circulation is directed away from the periphery and toward the core of the body. Clients in the last stages of dying are usually not calm and peaceful; they occasionally exhibit sudden restlessness due to hunger for oxygen.

The husband of a client with terminal cancer is afraid of hurting his wife during sexual intercourse. Which action by the nurse is likely to be most helpful in reducing this client's fears? Reassure the client's husband that he cannot hurt the client during sexual intercourse Inform the client's husband that the client cannot have sexual intercourse due to fatigue Encourage discussion between the husband and wife regarding their intimacy needs Suggest other ways the couple can spend time together, such as watching television together

Encourage discussion between the husband and wife regarding their intimacy needs Explanation: Partners of terminally ill clients may wish to be physically intimate with the dying person but are afraid of "hurting" him or her and may also be afraid that an open expression of sexuality is somehow "inappropriate" when someone is dying. Encourage discussion and suggest ways to be physically intimate that will meet the needs of both partners, such as a foot massage or embrace, and not just watching TV. Telling the client that he cannot have relations based on the fatigue of the client's spouse is not appropriate. Reassuring the client that he will not cause pain is incorrect.

A home hospice client who has Medicare is experiencing extreme pain at home and is refusing to receive inpatient care due to concerns over the cost of inpatient care. What teaching will the nurse include in the plan of care? Medicare does not cover pain control in the home, it must be in the inpatient care. Worry about payment should not be a concern for the client. Inpatient pain management for hospice patients is covered by Medicare. Medicare does not cover costs that are not directly related to the diagnosis.

Inpatient pain management for hospice patients is covered by Medicare. Explanation: Inpatient pain management is covered by Medicare as are any other Medicare-covered services needed to manage pain and other symptoms as recommended by the hospice team. Medicare will cover pain control in the home as well, but for extreme pain hospitalization may be required. Telling a client not to worry about payment does not educate about what services are available.

A nurse is conducting grief resolution for a client who lost his wife in a motor vehicle accident in which he was the driver. Which interventions best accomplish this goal? Select all that apply. Avoid identification of fears regarding the loss. Communicate acceptance of discussing the loss. Avoid making empathetic statements about the client's grief. Listen to expressions of grief. Include significant others in discussions and decisions as appropriate. Encourage the client's desire to keep silent about the event.

Listen to expressions of grief. Include significant others in discussions and decisions as appropriate. Communicate acceptance of discussing the loss. Explanation: Grief resolution involves dealing with the loss. Listening to the client's expressions of grief, including significant others in discussions, and communicating acceptance helps the client deal effectively with the loss. Encouraging the client to keep silent about the event, not being empathetic, and avoiding identification of fears does not help the client in dealing with the loss.

A nurse is providing care to pediatric clients on an oncology floor. The nurse would expect which age group as perceiving death as reversible, avoidable and occurring in degrees? Infants Toddlers School-age children Preschoolers

Preschoolers Explanation: Preschoolers perceive death as reversible, avoidable, and occurring in degrees. Infants have no concept of life and death. Toddlers experience a fear of abandonment. Early school-age children perceive death as unnatural, reversible and avoidable, and may also personify death.

A nurse caring for a client with a terminal illness understands which statement to be true? Recovery is dependent on selected treatment. Recovery will be longer than 3 months. Recovery is not expected. Recovery will be slow.

Recovery is not expected. Explanation: A terminal illness is a condition from which recovery is not expected. Clients with terminal illness do not recover from the illness; they may be treated symptomatically and be provided care and comfort. Recovery cannot be based on a time frame such as 3 months. Recovery is not dependent on the selected treatment as it is not expected.

A nurse at the health care facility cares for several clients. Some of the clients may require end-of-life care. Which case may require the service of a coroner? The client did not have any recent medical consultation. The client was being administered oxygen therapy. The client is elderly with a history of hypertension. The client was diagnosed with acute renal failure.

The client did not have any recent medical consultation. Explanation: The services of a coroner may be needed in a case where the client did not have any recent medical consultation. A coroner is a person legally designated to investigate deaths that may not be the result of natural causes. Death following a diagnosis of acute renal failure, administration of oxygen therapy, or a history of hypertension does not call for the services of a coroner.

The nurse is making sure that all factors are in place for a client's death certificate. What potential error that may occur does the nurse identify? The client was younger than 12 years of age or older than 75. The client had a condition that has the potential to temporarily suspend life process. The client lived with numerous comorbidities prior to death. The client was in good health prior to an accident or medical incident that caused death.

The client had a condition that has the potential to temporarily suspend life process. Explanation: Errors in certification of death have the potential to occur in conditions that might not permanently suspend life processes, such as from hypothermia, drug or metabolic intoxication, or circulatory shock. There is also a risk of error in children under 5 years of age. Previous good health or multiple comorbidities do not present a greatly increased risk of error when determining death.

The nurse is teaching a client with terminal cancer who is interested in hospice care. Which home hospice benefits will the nurse explain? Select all that apply.

The nurse and physician are on call 24 hours, every day of the week. Counseling services are available. Pain will be managed with medication, if needed. Homemaker services can be included.

A widow has just returned home from the funeral of her husband. She feels alone in her home. Her family has left to go back to their home in another area of the country. What stage of Engel's model does this represent? developing awareness resolving the grief shock and disbelief restitution

developing awareness Explanation: Developing awareness occurs as the reality and meaning of the loss penetrate the person's consciousness.

A critical care nurse is aware of the legislation that surrounds organ donation. When caring for a potential organ donor, the nurse is aware that: nursing focus should be directed at organ donation once it is decided to withdraw life support. clients must have an organ donor card to donate organs. non-heart-beating cadavers are not potential organ donors. hospitals are mandated to notify transplantation programs of potential donors.

hospitals are mandated to notify transplantation programs of potential donors. Explanation: The scarcity of organs has resulted in legislation mandating hospitals and other health care agencies to notify transplantation programs of potential donors. New protocols allow the retrieval of organs from non-heart-beating cadavers. The family of a deceased client may decide to donate the organs, and a donor card is not necessary in this circumstance. Attention to optimal client and family care at the time of life-sustaining therapy withdrawal should remain the nurse's priority in care

The experience of parting with an object, person, belief, or relationship that one values is defined as: bereavement. death. grief. loss.

loss. Explanation: Loss is defined as the experience of parting with an object, person, belief, or relationship that one values; the loss requires a reorganization of one or more aspects of the person's life.

Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning? Have the client's family remain at the bedside Administer sedation and analgesia Offer emotional support to the family Provide explanation of the process

Administer sedation and analgesia Explanation: Terminal weaning is the gradual withdrawal of mechanical ventilation from a client with a terminal illness. Providing sedation and analgesia are the best way to reduce the client's discomfort during the process. The nurse participates in the process by educating the client and family about the burdens and benefits of continued ventilation and what to expect when terminal weaning is initiated. Supporting the family and having the family remain at the bedside are important roles of the nurse during terminal weaning, but do not directly affect discomfort as much as sedation and analgesia.

Assisted suicide is expressly prohibited under statutory or common law in the overwhelming majority of states. Yet public support for physician-assisted suicide has resulted in a number of state ballot initiatives. The issue of assisted suicide is opposed by nursing and medical organizations as a violation of the ethical traditions of nursing and medicine. Which scenario would be an example of assisted suicide? Neglecting to resuscitate a client with a "do not resuscitate" status Administering a morphine infusion Granting a client's request not to initiate enteral feeding when the client is unable to eat Administering a lethal dose of medication

Administering a lethal dose of medication Explanation: Assisted suicide refers to providing another person the means to end his or her own life, such as administering a lethal dose of a medication. This is not to be confused with the ethically and legally supported practices of withholding or withdrawing medical treatment in accordance with the wishes of the terminally ill individual. Administering a morphine infusion may be used to assist with a client's pain near the end of life. Granting a client's request not to initiate enteral feeding when the client is unable to eat is an example of wishes of a terminally ill client, and the agreed-upon measures near the end of life. Neglecting to resuscitate a client with a "do not resuscitate" status is following the prescribed, mutually agreed-upon decisions about care.

A client has been declared brain dead following a fall from a roof. The client's advance directives state they do not wish to have prolonged life measures, and that only the heart, kidneys, and liver should be donated. The client's spouse wants to also donate the client's corneas. What is the appropriate nursing action?

Contact the organ procurement team to discuss organ donation with the spouse.

Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief? Self-care activities Coping strategies Pain management Spiritual distress

Coping strategies Explanation: Dysfunctional grief can be unresolved or inhibited. In unresolved grief, a person may have trouble expressing feelings of loss or may deny them. Unresolved grief also describes a state of bereavement that extends over a lengthy period. With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms. Coping strategies are necessary in the grieving process and for resolution of grief. Many times individuals experiencing dysfunctional grief have difficulty with self-care activities; however, the individual should be encouraged to perform these activities independently. Pain management is usually not necessary in the management of dysfunctional grief. The spiritual needs of the client are important as well and should be considered after coping strategies have been addressed.

The nurse has noted that a dying client is increasingly withdrawn and is often teary at various times during the day. The nurse recognizes that the client may be experiencing which of Kübler-Ross's stages of grief? Anger Depression Denial Bargaining

Depression Explanation: Depression is a commonly accepted form of grief and it represents the emptiness when the client realizes the person or situation is gone or over. Signs and symptoms may be withdrawn, sadness, crying, and flat affect. Denial is the stage where client may disregard that the news of diagnosis or death is not true. Anger is the stage where the client may think "why me?" and "life's not fair!" Bargaining is the stage of false hope. The client might falsely make themselves believe that they can avoid the grief through a type of negotiation. The stages are denial, anger, bargaining, depression, and acceptance.

The wife of a client who has been diagnosed with a terminal illness asks the nurse about the differences between palliative care and hospice care. Which information would the nurse most likely include in the response? Hospice provides physical and psychological support; palliative care provides social and spiritual support. Hospice care focuses on quality of life while palliative care focuses on length of life. Hospice care differs from palliative care in its foundational philosophy. Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness.

Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. Explanation: Hospice programs, which, in effect, are a type of insurance benefit, focus on relieving symptoms and supporting clients with a life expectancy of 6 months or less, and their families. Palliative care, on the other hand, may be given at any time during a client's illness, from diagnosis to end of life. Hospice and palliative care programs provide care that focuses on quality rather than length of life. Both hospice and palliative care share a similar foundation. Hospice and palliative care provide physical, social, psychological, and spiritual support through a team of health care professionals and lay volunteers.

A client has been diagnosed with a terminal illness and has periods of depression and periods of anger, alternating with periods of acceptance. What teaching is most appropriate for the nurse to include when the client's spouse says that the client seems emotionally unstable? Depression is not a stage in the grief process. Acceptance cannot take place until other grief is resolved. The client does sound unstable and should seek help. Movement between stages of grief is normal.

Movement between stages of grief is normal. Explanation: Stages of grief may occur in a progressive fashion, or a person can move back and forth through the stages. There is no specific time period for the rate of progression, duration, or completion of the stages.

The emergency department (ED) nurse accepts an unconscious client brought in by ambulance. The client's family presents a durable power of attorney for health care for the client. Which action should the nurse take? Initiate active euthanasia. Initiate a slow code in the case of cardiopulmonary or respiratory arrest. Communicate to other ED staff that there should be no attempts to resuscitate the client. Obtain contact information for the person designated to make decisions for the client.

Obtain contact information for the person designated to make decisions for the client. Explanation: Advance directives can minimize difficulties by allowing people to state in advance what their choices would be for health care should certain circumstances develop. A durable power of attorney for health care appoints an agent that the person trusts to make decisions in the event of subsequent incapacity. In this case of an unconscious client, the nurse would want to obtain contact information for the person designated by the client as decision-maker. The durable power of attorney does not give direction regarding medical care (answers B,C,D).

A client in a long-term care facility has signed a form stating that he does not want to be resuscitated. He develops an upper respiratory infection that progresses to pneumonia. His health rapidly deteriorates, and he is no longer competent. The client's family states that they want everything possible done for the client. What should happen in this case?

The client should be treated with antibiotics for pneumonia. Explanation: The client has signed a document indicating a wish not to be resuscitated. Treating the pneumonia with antibiotics is not a resuscitation measure. The other options do not respect the client's right to choice.

A client in a long-term care facility has signed a form stating that he does not want to be resuscitated. He develops an upper respiratory infection that progresses to pneumonia. His health rapidly deteriorates, and he is no longer competent. The client's family states that they want everything possible done for the client. What should happen in this case? Pharmacologic interventions should not be initiated. The client should be treated with antibiotics for pneumonia. The client should be resuscitated if he experiences respiratory arrest. The wishes of his family should be followed.

The client should be treated with antibiotics for pneumonia. Explanation: The client has signed a document indicating a wish not to be resuscitated. Treating the pneumonia with antibiotics is not a resuscitation measure. The other options do not respect the client's right to choice.

Which does not coincide with Kübler-Ross's stages related to a dying client? Some client regress, then move forward again. The dying client usually exhibits anger first. Clients don't always follow the stages in order. The client may be in several stages at once.

The dying client usually exhibits anger first. Explanation: The dying client does not usually exhibit anger first. The client may be in several stages at once, clients don't always follow the stages in order, and some regress and then move forward.

Which does not coincide with Kübler-Ross's stages related to a dying client? The dying client usually exhibits anger first. The client may be in several stages at once. Some client regress, then move forward again. Clients don't always follow the stages in order.

The dying client usually exhibits anger first. Explanation: The dying client does not usually exhibit anger first. The client may be in several stages at once, clients don't always follow the stages in order, and some regress and then move forward.

A client has been declared brain dead following a motor vehicle accident. What assessment data would the nurse anticipate? no ocular movement sluggish pupillary response breathing drive triggered only by respirator positive corneal response

no ocular movement Explanation: All brainstem reflexes would be absent (including pupillary response, corneal reflex, ocular movements). The respiratory drive would be absent.

A client has been declared brain dead following a motor vehicle accident. What assessment data would the nurse anticipate? no ocular movement positive corneal response breathing drive triggered only by respirator sluggish pupillary response

no ocular movement Explanation: All brainstem reflexes would be absent (including pupillary response, corneal reflex, ocular movements). The respiratory drive would be absent.v

A nurse is assessing a client's grief response. Which concept would be most important for the nurse to keep in mind during the assessment to determine whether the client's response is normal or altered? the degree of shock and disbelief being exhibited. evidence of nightmares and hallucinations about the loss the degree of depression and statements of self-harm severity of the symptoms and the pattern of change over time

severity of the symptoms and the pattern of change over time Explanation: Although depressive symptoms, possible self-harm, shock, disbelief, nightmares, and hallucinations may be part of the grief response, the nurse must assess the severity of the symptoms and the pattern of change over time to distinguish between normal and altered grief reactions. Observation and assessment of a grieving person at a single point in time is not a good way to assess the normality of the grief response.

Following surgery, the surgeon informed the client's spouse that invasive cancer was found during the procedure and the client may only have days to live. The client's spouse has told the physician and the nurse that they do not want the client to know the severity of the diagnosis. How will the nurse respond? understanding that learning about impending death will create unnecessary worry understanding that the client's spouse has the right to direct care for the dying client understanding that this directive would violate the client's rights not disclosing any information to the client

understanding that this directive would violate the client's rights Explanation: The dying client's bill of rights includes the right to not be deceived and to receive truthful answers regarding prognosis and care. The nurse will be honest with the client. Impending worry will likely occur, but the client has a right to know their prognosis and the client's spouse does not have the right to direct care.